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D. Veritti, P. Lanzetta, F. Bandello; Posterior Juxtascleral Infusion of Modified Triamcinolone Acetonide Formulation for Refractory Diabetic Macular Edema. One-Year Follow Up. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3489.
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To evaluate prospectively the efficacy and safety of posterior juxtascleral infusion of a new formulation of triamcinolone acetonide for refractory diffuse diabetic macular edema.
Non randomized clinical trial. Twenty-two consecutive eyes of 18 patients with refractory diffuse diabetic macular edema were included in the study. Each patient received a complete ophthalmologic examination, including measurement of best corrected visual acuity, applanation tonometry, macular mapping using optical coherence tomography and digital fluorescein angiography. All patients received a suspension of 40 mg triamcinolone acetonide, 20 mg sodium chondroitin sulphate and 15 mg sodium hyaluronate (1.5 ml), delivered posteriorly through a small conjunctival and Tenon's incision. Patients were scheduled for follow-up examinations at 7 days, 1, 3, 6, 9 and 12 months. Eyes were retreated acording to OCT findings. All patients completed the one-year follow-up.
In none of the procedures drug reflux was observed. On average, studied eyes received 1.5 treatments. One infusion only was given in 54.5% of eyes. Mean preoperative foveal thickness (± SD) and visual acuity (± SD) were 472.5 ±138.9 µm and 0.6 ±0.37 logMAR respectively. Central foveal thickness was significantly reduced from baseline at every follow-up visit [p<0.001]. Mean (± SD) reductions in macular thickness were 134±109 µm at 1 week, 153±108 µm after 1 month, 133±116 µm after 3 months, 104±106 µm after 6 months, 158±133 µm after 9 months and 126±122 µm after 1 year of follow-up. Mean (± SD) improvement in visual acuity 1, 3, 6, 9 and 12 months after treatment were 0.11±0.14 logMAR [p=0.001], 0.15±0.24 logMAR [p=0.007], 0.16±0.25 logMAR [p=0.009], 0.15±0.22 logMAR [p=0.005] e 0.15±0.21 logMAR [p=0.008], respectively. Visual acuity improvement of one or more line and three or more lines were observed in 14 eyes (63.6%) and 6 eyes (27.3%) respectively. Seven eyes (31.8%) required topical treatment due to significant intraocular pressure increase.
Posterior juxtascleral infusion of a new formulation of triamcinolone acetonide is an effective treatment of diffuse diabetic macular edema unresponsive to conventional grid laser photocoagulation.
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